2015 May - The diagnostic accuracy of chest ultrasound for CT-detected radiographic consolidation in hospitalised adults with acute respiratory failure: a systematic review
Hew M, Corcoran JP, Harriss EK, Rahman NM, Mallett S. ;BMJ Open. 2015 May 19;5(5):e007838.
OBJECTIVES: (1) Summarise chest ultrasound accuracy to diagnose radiological consolidation, referenced to chest CT in patients with acute respiratory failure (ARF). (2) Directly compared ultrasound with chest X-ray.
Lenz K, Buder R, Kapun L, Voglmayr M.; Therap Adv Gastroenterol. 2015 Mar;8(2):83-100
Ascites and renal dysfunction are frequent complications experienced by patients with cirrhosis of the liver. Ascites is the pathologic accumulation of fluid in the peritoneal cavity, and is one of the cardinal signs of portal hypertension. The diagnostic evaluation of ascites involves assessment of its granulocyte count and protein concentration to exclude complications such as infection or malignoma and to allow risk stratification for the development of spontaneous peritonitis.
2015 Feb - Evidence-based guidelines for the management of large hemispheric infarction : a statement for health care professionals from the neurocritical care society and the german society for neuro-intensive care and emergency medicine
Torbey MT, Bösel J, Rhoney DH, Rincon F, Staykov D, Amar AP, Varelas PN, Jüttler E, Olson D, Huttner HB, Zweckberger K, Sheth KN, Dohmen C, Brambrink AM, Mayer SA, Zaidat OO, Hacke W, Schwab S.: Neurocrit Care. 2015 Feb;22(1):146-64.
Large hemispheric infarction (LHI), also known as malignant middle cerebral infarction, is a devastating disease associated with significant disability and mortality. Clinicians and family members are often faced with a paucity of high quality clinical data as they attempt to determine the most appropriate course of treatment for patients with LHI, and current stroke guidelines do not provide a detailed approach regarding the day-to-day management of these complicated patients. To address this need, the Neurocritical Care Society organized an international multidisciplinary consensus conference on the critical care management of LHI.
Jordan JD, Morbitzer KA, Rhoney DH.; Neurol Clin. 2015 May;33(2):361-380.
Blood pressure elevation in the setting of acute ischemic stroke and intracerebral hemorrhage is common. Controversy exists as to the optimal management of elevated blood pressure in this patient population. This article reviews the available clinical data that guides acute blood pressure management and how this may affect clinical outcomes.
2015 Mar - A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study
Lall R, Hamilton P, Young D, Hulme C, Hall P, Shah S, MacKenzie I, Tunnicliffe W, Rowan K, Cuthbertson B, McCabe C, Lamb S. Health Technol Assess. 2015 Mar;19(23):1-178.
BACKGROUND: Patients with the acute respiratory distress syndrome (ARDS) require artificial ventilation but this treatment may produce secondary lung damage. High-frequency oscillatory ventilation (HFOV) may reduce this damage.
Navarro LH, Bloomstone JA, Auler JO Jr, Cannesson M, Rocca GD, Gan TJ, Kinsky M, Magder S, Miller TE, Mythen M, Perel A, Reuter DA, Pinsky MR, Kramer GC. Perioper Med (Lond). 2015 Apr 10;4:3.
BACKGROUND: Perioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. Maintaining effective circulating blood volume and pressure are key components of assuring adequate organ perfusion while avoiding the risks associated with either organ hypo- or hyperperfusion. Relative to perioperative fluid therapy, three inescapable conclusions exist: overhydration is bad, underhydration is bad, and what we assume about the fluid status of our patients may be incorrect. There is wide variability of practice, both between individuals and institutions. The aims of this paper are to clearly define the risks and benefits of fluid choices within the perioperative space, to describe current evidence-based methodologies for their administration, and ultimately to reduce the variability with which perioperative fluids are administered.
2015 Mar - HMG CoA reductase inhibitors (statins) for preventing acute kidney injury after surgical procedures requiring cardiac bypass
Lewicki M, Ng I, Schneider AG.; Cochrane Database Syst Rev. 2015 Mar 11;3:CD010480.
BACKGROUND: Acute kidney injury (AKI) is common in patients undergoing cardiac surgery among whom it is associated with poor outcomes, prolonged hospital stays and increased mortality. Statin drugs can produce more than one effect independent of their lipid lowering effect, and may improve kidney injury through inhibition of postoperative inflammatory responses.
2015 Apr - Prolonged Mild Therapeutic Hypothermia versus Fever Control with Tight Hemodynamic Monitoring and Slow Rewarming in Patients with Severe Traumatic Brain Injury: A Randomized Controlled Trial.
Maekawa T, Yamashita S, Nagao S, Hayashi N, Ohashi Y.; J Neurotrauma. 2015 Apr 1;32(7):422-9.
Although mild therapeutic hypothermia is an effective neuroprotective strategy for cardiac arrest/resuscitated patients, and asphyxic newborns, recent randomized controlled trials (RCTs) have equally shown good neurological outcome between targeted temperature management at 33°C versus 36°C, and have not shown consistent benefits in patients with traumatic brain injury (TBI)..
Poropat G, Giljaca V, Hauser G, Štimac D.; Cochrane Database Syst Rev. 2015 Mar 23;3:CD010605. [Epub ahead of print]
BACKGROUND: Acute pancreatitis is a common and potentially lethal disease with increasing incidence. Severe cases are characterised by high mortality, and despite improvements in intensive care management, no specific treatment relevantly improves clinical outcomes of the disease. Meta-analyses suggest that enteral nutrition is more effective than conventional treatment consisting of discontinuation of oral intake with use of total parenteral nutrition. However, no systematic review has compared different enteral nutrition formulations for the treatment of patients with acute pancreatitis.
2015 Apr - The Role of Neuromuscular Blockade in Patients with Traumatic Brain Injury: A Systematic Review
Sanfilippo F, Santonocito C, Veenith T, Astuto M, Maybauer MO.; Neurocrit Care. 2015 Apr;22(2):325-34.
Management offocuses on controlling intracranial pressure (ICP), while other treatments, such as the use of neuromuscular blocking agents (NMBAs), need scientific evidence. We conducted a systematic review to investigate the usefulness of NMBAs in the context of TBI and/or increased ICP...
2015 Apr - Rapid Unexpected Brain Herniation in Association with Renal Replacement Therapy in Acute Brain Injury: Caution in the Neurocritical Care Unit
Osgood M, Compton R, Carandang R, Hall W, Kershaw G, Muehlschlegel S.; Neurocrit Care. 2015 Apr;22(2):176-83.
Introduction: We aim to raise awareness for the potential for rapid brain edema and herniation in acutely brain-injured patients undergoing renal replacement therapy (RRT), including one case undergoing continuous veno-venous hemofiltration. Dialysis disequilibrium syndrome (DDS) may have been a possible cause for the brain edema.
Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, Binh NG, Tan CC, Faruq MO, Arabi YM, Wahjuprajitno B, Liu SF, Hashemian SM, Kashif W, Staworn D, Palo JE, Koh Y; ACME Study Investigators and the Asian Critical Care Clinical Trials Group.; JAMA Intern Med. 2015 Mar 1;175(3):363-71.
IMPORTANCE: Little data exist on end-of-life care practices in intensive care units (ICUs) in Asia.
OBJECTIVE: To describe physicians' attitudes toward withholding and withdrawal of life-sustaining treatments in end-of-life care and to evaluate factors associated with observed attitudes.
2015 Feb - High-dose simvastatin for aneurysmal subarachnoid hemorrhage: multicenter randomized controlled double-blinded clinical trial
Wong GK, Chan DY, Siu DY, Zee BC, Poon WS, Chan MT, Gin T, Leung M; HDS-SAH Investigators.; Stroke. 2015 Feb;46(2):382-8.
BACKGROUND AND PURPOSE: Experimental evidence has indicated the benefits of simvastatin for the treatment of subarachnoid hemorrhage. Two randomized placebo-controlled pilot trials that used the highest clinically approved dose of simvastatin (80 mg daily) gave positive results despite the fact that a lower dose of simvastatin (40 mg daily) did not improve clinical outcomes. We hypothesized that a high dose of 80 mg of simvastatin daily for 3 weeks would reduce the incidence of delayed ischemic deficits after subarachnoid hemorrhage compared with a lower dose (40 mg of simvastatin daily) and lead to improved clinical outcomes.
2015 Jan - Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial
Cavallin M, Kamath PS, Merli M, Fasolato S, Toniutto P, Salerno F, Bernardi M, Romanelli RG, Colletta C, Salinas F, Di Giacomo A, Ridola L, Fornasiere E, Caraceni P, Morando F, Piano S, Gatta A, Angeli P; for the Italian Association for the Study of Liver (AISF) study group on HRS.; Hepatology. 2015 Jan 16.
Background: Hepatorenal syndrome (HRS), a serious complication of cirrhosis, is associated with high mortality without treatment. Terlipressin with albumin is effective in the reversal of HRS. Where terlipressin is not available as in the United States, midodrine and octreotide with albumin is used as an alternative treatment of HRS. The aim was to compare the effectiveness of terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in a randomized controlled trial.
Tramm R, Ilic D, Davies AR, Pellegrino VA, Romero L, Hodgson C.; Cochrane Database Syst Rev. 2015 Jan 22;1:CD010381
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a form of life support that targets the heart and lungs. Extracorporeal membrane oxygenation for severe respiratory failure accesses and returns blood from the venous system and provides non-pulmonary gas exchange. Extracorporeal membrane oxygenation for severe cardiac failure or for refractory cardiac arrest (extracorporeal cardiopulmonary resuscitation (ECPR)) provides gas exchange and systemic circulation. The configuration of ECMO is variable, and several pump-driven and pump-free systems are in use. Use of ECMO is associated with several risks. Patient-related adverse events include haemorrhage or extremity ischaemia; circuit-related adverse effects may include pump failure, oxygenator failure and thrombus formation. Use of ECMO in newborns and infants is well established, yet its clinical effectiveness in adults remains uncertain.
OBJECTIVES: The primary objective of this systematic review was to determine whether use of veno-venous (VV) or venous-arterial (VA) ECMO in adults is more effective in improving survival compared with conventional respiratory and cardiac support.
2015 Feb - Blood conservation in extracorporeal membrane oxygenation for acute respiratory distress syndrome
Agerstrand CL, Burkart KM, Abrams DC, Bacchetta MD, Brodie D.; Ann Thorac Surg. 2015 Feb;99(2):590-5.
BACKGROUND: Extracorporeal membrane oxygenation support (ECMO) typically requires multiple blood transfusions and is associated with frequent bleeding complications. Blood transfusions are known to increase morbidity and mortality in critically ill patients, which may extend to patients receiving ECMO. Aiming to reduce transfusion requirements, we implemented a blood conservation protocol in adults with severe acute respiratory distress syndrome (ARDS) receiving ECMO.
2015 Jan - Milrinone for the Treatment of Acute Heart Failure After Acute Myocardial Infarction: A Systematic Review and Meta-analysis
Tang X, Liu P, Li R, Jing Q, Lv J, Liu L, Liu Y. ;Basic Clin Pharmacol Toxicol. 2015 Jan 27. doi: 10.1111/bcpt.12385. [Epub ahead of print]
Despite advancements in modern medicine, the treatment of acute heart failure (AHF) after acute myocardial infarction (AMI) remains challenging. Milrinone is effective in the treatment of chronic congestive heart failure, but its safety and efficacy in patients with AHF after AMI have not been systematically evaluated. This meta-analysis was performed to assess the safety and efficacy of milrinone in patients with AHF after AMI.
2015 Jan - Mild induced hypothermia: Effects on sepsis-related coagulopathy -results from a randomized controlled trial
Johansen ME, Jensen JU, Bestle MH, Ostrowski SR, Thormar K, Christensen H, Pedersen HP, Poulsen L, Mohr T, Kjær J, Cozzi-Lepri A, Møller K, Tønnesen E, Lundgren JD, Johansson PI.; Thromb Res. 2015 Jan;135(1):175-82. doi: 10.1016/j.thromres.2014.10.028. Epub 2014 Nov 5.
INTRODUCTION: Coagulopathy associates with poor outcome in sepsis. Mild induced hypothermia has been proposed as treatment in sepsis but it is not known whether this intervention worsens functional coagulopathy.
2015 Jan - Predictive value of NGAL for use of renal replacement therapy in patients with severe sepsis
Hjortrup PB, Haase N, Treschow F, Møller MH, Perner A.; Acta Anaesthesiol Scand. 2015 Jan;59(1):25-34
BACKGROUND: The predictive value of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) for use of renal replacement therapy (RRT) and acute kidney injury (AKI) is not established in patients with severe sepsis.
2014 Nov - Systematic Review of the Literature and Evidence-Based Recommendations for Antibiotic Prophylaxis in Trauma: Results from an Italian Consensus of Experts
Poole D, Chieregato A, Langer M, Viaggi B, Cingolani E, Malacarne P, Mengoli F, Nardi G, Nascimben E, Riccioni L, Turriziani I, Volpi A, Coniglio C, Gordini G; Trauma Update Working Group.; PLoS One. 2014 Nov 20;9(11):e113676.
BACKGROUND: Antibiotic prophylaxis is frequently administered in severe trauma. However, the risk of selecting resistant bacteria, a major issue especially in critical care environments, has not been sufficiently investigated. The aim of the present study was to provide guidelines for antibiotic prophylaxis for four different trauma-related clinical conditions, taking into account the risks of antibiotic-resistant bacteria selection, thus innovating previous guidelines in the field.